San Francisco Health Director Barbara Garcia is bowing to
Mayor Ed Lee's office as she opposes trying to cut transmission of HIV and
other diseases by distributing crack pipes to drug users, city officials'
emails to each other and interviews with the Bay Area Reporter
suggest.

Garcia, who quickly became defensive last week when asked to
explain her stance, and Lee's staff have repeatedly refused to explain their
opposition.

But emails from Lee spokeswoman Christine Falvey to Garcia
and other Department of Public Health staff warn them to be careful of the
city's image.

Falvey, who was concerned about a January 24 TV news story
about the crack pipe idea, wrote that day in an email to Garcia and her staffer
Colleen Chawla, "Can you clear up with KPIX – don't want any Fox
News SF headlines on this."

Chawla is the health department's deputy director of health
and the director of policy and planning for the agency. Falvey's email was one
of many obtained through B.A.R. public
records act requests.

"Need to make sure everyone understands the City of SF
is not collecting data, exploring this, etc. ... please clear this up
ASAP," Falvey wrote about half an hour after her first message, in another
email to Chawla, on which Garcia was copied.

Falvey also emailed the news station January 24, after its
initial story ran, saying, "Mayor Lee is not aware of this exploration and
is not supportive. There are many other HIV interventions that could and should
be explored before ever considering this."

KPIX reported that Garcia then said in a phone call,
"That recommendation has not come to me. And I'm telling you that if it
did, I would say 'absolutely no, we are not going to distribute crack pipes.'
We have a lot of things to consider for those who are using crack for improving
their health. And the distribution of crack pipes is not something I'm going to
consider."

At their January 9 meeting, members of the HIV Prevention
Planning Council, an advisory group to the health department that sets
priorities for HIV prevention in the city, voted unanimously to support an
action plan that includes collecting data and exploring legal issues around
crack pipe distribution.

In a Friday, February 14 interview with the B.A.R.
, Garcia became combative.

When a reporter tried to ask Garcia about Falvey's emails
indicating the mayor's office is taking the lead on public health, Garcia said,
"I understand what you're trying to get at, but I'm not going to talk about
other people's emails."

"You just want a lot of newsworthy stupid stuff. I'm
not going to do that with you," she said.

Garcia, an out lesbian, said she'd approved exploring
"data about the needs of crack users." She didn't allow for a chance
to ask why she would approve exploring the data if she's not going to even
consider distributing the pipes.

Asked whether the mayor had talked to her about it, she
said, "That's the end of this conversation." She stayed on the phone
but refused to answer other questions.

Finally, she said, "I'm going to leave now, and I want
to give you a happy Valentine's Day. ... That's the end of it. Bye." She
then hung up the phone.

Apparent contrast

Garcia's most recent comments are in contrast to where she
appeared to be on the issue of crack pipes over a month ago.

In a January 10 email to Garcia and an executive assistant,
longtime DPH staffer Tracey Packer wrote of the B.A.R.
's presence at the previous day's meeting, during
which the crack pipe action plan was approved, and told her that the paper was
asking for more information.

Packer co-chairs the HPPC and also serves as director of
community health equity and promotion for the health department's population
health division.

In her email, she said, "I wonder if I can talk to [the
B.A.R.] beyond providing information
about what happened at the meeting." She included details of the
four-point action plan in her message.

"Please advise if I can talk to [the reporter], and any
other comments you have," wrote Packer.

In response to emailed questions last week, Falvey wouldn't
say why exactly Lee opposes distributing the pipes, and she wouldn't directly
answer several questions, including whether anyone in the mayor's office had
instructed Garcia or her staff to come out against the idea.

"The mayor and the mayor's office is relying on the
public health department and public health experts to assess and implement the
best interventions for HIV prevention," said Falvey.

She added that the intent of her January 24 emails "was
to make sure the correct information was provided to the media. As you know,
misinformation can do more harm to our best efforts to prevent HIV
transmission, especially by people who may politicize the issue and diminish
the good work of the health department and others who are trying to develop
programs that will ultimately save lives."

In a phone interview, Lani Kent, Lee's senior policy adviser
on health, said she's also opposed to the idea, but like the others, she
wouldn't provide specific reasons.

"Initially, that's not anything I would support,"
said Kent, who said there was a report that listed distributing crack pipes
among other recommendations. "I would want more information" about
the benefits of handing out pipes.

Kent didn't have much information on whatever report she was
referring to. She said she'd learned of it from Packer. In one email to Kent,
Packer had referred to the HPPC's action plan and said a work group of the
panel was being convened. Packer didn't respond to a request for comment.

Even if she did have more information, Kent said she's not
open to supporting the idea of distributing crack pipes.

Asked why not, she said, "I'm just not."

Kent said she has a meeting with the mayor that's
"being calendared."

"I wouldn't make a stance on anything until checking
with my health department," she said. " ... I trust my department and
their process, and I don't think they've had the opportunity to vet" the
recommendations.

As for why Lee would take a stance against distributing
crack pipes before the data's been vetted, Kent said the question was being
"asked without [the] context" of the other recommendations from the
report.

Some city officials, including District Attorney George
Gascón and a spokeswoman for Police Chief Greg Suhr, have expressed openness to
the idea of providing crack pipes, as has gay Supervisor Scott Wiener.

HPPC member Laura Thomas, who's also on the HIV Health
Services Planning Council and deputy state director for California for the Drug
Policy Alliance, said that she and other advocates met with Wiener's aide Adam
Taylor, at Wiener's office's request, in early February to brief Taylor on the
issue.

In an interview this week, Wiener called the meeting
"helpful," but he indicated it didn't sway him one way or another and
he'd "let [the] process unfold" at the health department.

Asked whether it would concern him if the mayor's office
were pressuring that agency, he said, "I don't want to comment on
relations in the mayor's office and DPH. I will say it's important for DPH to
make decisions based on science, and I've known Barbara Garcia for a long
time." He said in his experience with Garcia, "I always have the
sense she really is approaching issues based on her professional best judgment.
I have a lot of respect for her."

Going ahead anyway

It may not matter much what city officials think of the idea
of distributing crack pipes. At least one organization is planning to hand them
out anyway.

Isaac Jackson, a gay man who serves as president of Urban
Survivors Union, said that his group would start handing out pipes on a weekly
basis in March. He declined this week to share the specific time or location.

San Francisco has years of experience with needle exchange,
which is credited with decreasing HIV transmission rates. The risks of
contracting HIV from sharing a pipe may not be as great as it is from sharing a
needle, but Jackson, Thomas, and others have spoken about the usefulness of engaging
with crack users.

Advocates say the outreach could help reduce people's risky
sexual practices and ensure that people know their HIV status, among other
benefits.

Crack pipes have been distributed in cities including
Seattle and Toronto for years. People involved in harm reduction efforts there
indicated controversy has been minimal, but health department officials say
they don't have data on the distribution's effectiveness.

Locally, Jackson sounds tired of waiting for city support.

In an email, he said, "Looking the other way while
crack is smoked with broken, blood stained pipes passed on to another user with
burnt lips is not an effective policy when it comes to preventing blood-borne
pathogens."